POS1483-HPR DYSFUNCTIONAL COPING CORRELATES WITH DEPRESSION AND ANXIETY AND PREDICTS WORSE OUTCOME IN PATIENTS WITH A HIGH DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS
Authors: J. R. Hoeper, I. Iliadis, M. Richter, S. E. Meyer, K. Kahl, T. Witte, K. Hoeper, D. Meyer-Olson
Journal: Annals of the Rheumatic Diseases (2022)

Background Disease flares of rheumatoid arthritis (RA) are important stressors for patients (pts) who may use coping for disease management. Some coping styles are thought to be beneficial and may help to improve disease outcome whereas others are thought to be harmful. Objectives We investigate the frequency and intensity of different coping styles in pts with an acute flare of seropositive RA and its impact on disease outcomes after 12 month of therapy. Methods Coping was analysed with the Brief-COPE (1) using a 4 point Likert scale in 222 pts participating in the ERFASS study (2). Coping styles were analysed by confirmatory and exploratory factor analysis (CFA, EFA). Disease activity was measured via DAS28 (CRP), depression and/or anxiety using Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire 9 (PHQ-9). Repeated measures ANOVA was used to identify the effect of different coping strategies on disease activity and Spearman-Rho to identify correlations. Results Factor analysis revealed five dominant coping styles (problem oriented, emotion oriented, dysfunctional, religion, alcohol/drugs) which were consistent during 6 and 12 months follow up. When analysing the relative intensity of each coping strategy over time there was no significant change during treatment (Table 1). The usage of only a single coping style at baseline (“I am doing this a medium amount” or “a lot”) was reported by 70 pts (31,5%). 65 pts (29,3%) reported the use of 2 coping styles simultaneously, 25 pts (11,3%) 3 coping styles and 4 pts (1,8%) four coping styles. Problem oriented coping was used by 125 pts (56,3%), emotional coping by 97 pts (43,7%), dysfunctional coping by 41 pts (18,5%), religion by 24 pts (10,8%) and alcohol/drugs by only 4 pts (1,8%). 58 pts (26,1%) reported not to use any of the coping styles (“I am doing this not at all” or “only a little bit”) and these pts had a lower DAS28 during the course of the study (p=0.036) as compared to pts who use one or more coping strategies. When analysing the group with high disease activity (DAS28 &gt;5.1) at baseline (n=60), pts with medium or high dysfunctional coping had a significantly higher disease activity after 12 months as compared to those with no or little dysfunctional coping (U = 187,00, Z = -2.025, p = 0.043) (Figure 1). The other coping styles did not significantly predict the outcome of disease activity. We observed a strong correlation between dysfunctional coping and depression (PHQ9 r = 0.590; HADS depression r = 0.569) as well as anxiety (HADS anxiety r = 0.639) but not for the other coping strategies at baseline. Figure 1. Table 1. Development of disease activity (DAS28) and coping strategies over time Time Baseline mean (SD) Month 6 mean (SD) Month 12 mean (SD) DAS28 4.32 (1.14) 2.79 (1.23) 2.47 (1.05) Problem oriented 53.10 (14.93) 49.69 (14.10) 47.43 (14.00) Emotion oriented 49.94 (13.00) 50.73 (12.76) 50.46 (13.45) Dysfunctional 40.25 (14.59) 36.44 (11.76) 36.00 (12.26) Religion 36.15 (18.30) 35.53 (17.02) 34.68 (16.64) Alcohol / Drugs 27.03 (7.81) 27.15 (8.75) 26.53 (6.07) Conclusion Different ways of coping may be used simultaneously during an acute flare of seropositive RA. In pts with high disease activity dysfunctional coping is the only coping strategy predicting a worse disease outcome after 12 months and dysfunctional coping correlates with depression and anxiety. References [1]Carver CS (1997) You want to measure coping but your protocol’s too long: consider the brief COPE. Int J Behav Med 4(1):92–100. [2]Hoeper JR, Zeidler J, Meyer SE, et al. Effect of nurse-led care on outcomes in patients with ACPA/RF-positive rheumatoid arthritis with active disease undergoing treat-to-target: a multicentre randomised controlled trial. RMD Open 2021 Disclosure of Interests Juliana Rachel Hoeper: None declared, Ioana Iliadis: None declared, Marianne Richter: None declared, Sara Eileen Meyer: None declared, Kai Kahl: None declared, Torsten Witte: None declared, Kirsten Hoeper Speakers bureau: Abbvie, Novartis, Galapagos, Sandoz Hexal, Chugai, Lilly, Consultant of: Abbvie, Novartis, Galapagos, Sandoz Hexal, Dirk Meyer-Olson Speakers bureau: Bristol Myers Squibb, Celltrion, Chugai, Fresenius Kabi, Galapagos, Lilly, Sandoz Hexal , Consultant of: Abbvie, Amgen, Astra Zeneca, Biogen, Novartis, Viatris